At the time of writing, a total of 31,855 people have died from COVID-19 infection in the UK (Department of Health & Social Care, 2020). This includes at least 90 health and Social Care workers. Every Thursday evening people across the UK stand outside their houses and clap, bang pots and sing the praise of the National Health Service (NHS) and Social Care staff for putting their lives on the line to fight COVID-19. They are joined by the fire, police, coast guard and mountain rescue services in doing so. It is an overwhelming expression of national cohesiveness and gratitude.

It is highly likely they are also celebrating one of the founding principles of the NHS, that is free care at the point of contact, which has remained relatively untouched since its inception in 1946. I say relatively because there have been numerous inroads by successive governments to erode this right in that we also have private health and social care in the UK. For example, Social Care for the elderly includes private care homes, local government care homes, community care services and charities.

In Scotland of a total of 2,795 COVID-19 related deaths, 49% were in hospital, 43% in care homes and 8% in community settings (National Records for Scotland 2020a). Those affected were mainly elderly people over the age of 75 years. Many of those in care homes and community care settings are likely to be diagnosed with mental illness such as dementia in addition to underling health problems that leave them susceptible to the most serve form of COVID-19 infection.

A key issue is the way in which the NHS and Social Care sector has responded to COVID-19. The NHS has been quick to redesign and repurpose its clinical facilities including: increasing intensive care capacity to cope with an upsurge in demand; providing staff with personal protective equipment to reduce the risk of infection; and reinforcing the workforce with, for example, student nurses including those training in mental health. Testing for the presence of COVID-19 is also available for staff and patients in each sector, although testing was introduced much later in Social Care (Nursing Standard, 2020). This also applies to the provision of personal protective equipment and workforce reinforcements (Guardian, 2020a). There was a lag in reporting the number of deaths in care homes compared with those among the general population (Guardian, 2020b). Scotland did so on the 15th April date, and the UK government did so on the 28th of April 2020 (Department of Health & Social Care, 2020; National Records For Scotland 2020b).

The disparity in response is not the fault of those working in the Social Care sector who have done their upmost to look after those who have died from COVID-19 infection often at a personal cost to themselves, including the heightened risk of becoming infected and spreading infection to their families and friends. Also, as reported in numerous media stories in the UK, is the the emotional trauma they experience from providing palliative care to very frail elderly people who they often considered as second family. It involves negotiating the extremely difficult and sensitive issue of personal contact with families of those who are dying or infected from COVID-19, in addition to those who are not infected and require to be shielded from the disease. This is a testing time, and the care staff including nurses have undoubtedly excelled in their response to it.

Legislation introduced in 1990 (The National Archives, 2020) handed care of the elderly to local government and since then there has been two-tier system between the NHS and Social Care. Social Care in the UK is funded from separate sources: private fees, charity and local authorities whilst the NHS is funded by central government. The disparity in funding means that those who cannot afford to pay are unlikely to access care in the private sector. There is also disparity in staff pay. The average pay of Social Care staff is below that of most supermarket workers (The Kings Fund, 2019).

A key question is whether any of these differences explain the disparity in response to COVID-19 between the two sectors? Given the different funding mechanisms, it might be concluded that supply chains in the Social Care differ across the sector including that for personal protective equipment, in particular that not normally supplied to the sector such as full-face masks and whole body protection. In addition, unqualified staff may not have the required level of training to use this equipment and isolation techniques such as barrier nursing. Information systems may also lag behind those in the NHS through lack of investment or perceived need. We should not forget the austerity policies of the UK government in the last 10 years which resulted in cutbacks to Social Care services and the fragmentation of the sector. All of this is likely to have led to a mixed and delayed response to the disease.

The 1990 Act, although well meaning has been severely tested by COVID-19. Some may call for better partnership working as a possible solution. However, this has proven problematic in reacting quickly to the crises. An alternative and possibly long-term solution would be to take Social Care into public ownership and into the NHS thereby streamlining staff training, procurement, data reporting systems and ensuring equitable pay and conditions for those who work in the sector.

The key question is whether government will take the opportunity of COVID-19 pandemic to do so (the new normal) or reset the Socail Care sector as it was before. Should we experience a second wave of COVID-19 infections, the Social Care sector should be better prepared to cope. However, the real test will be in the longer term when a new virus develops, or COVID-19 mutates, and another pandemic hits. When this happens I wonder whether people will be clapping publically owned Social Care that is truly part of the NHS?